In the past several weeks, Deputy Head of Medical Oncology at Humanitas and Professor of Humanitas University Pr. Lorenza Rimassa has participated in three important international meetings dedicated to oncology (The Digital International Liver Congress organized by The European Association for the Study of the Liver on August 27-29, International Liver Cancer Association Congress on September 11-13 and The European Society for Medical Oncology Congress on September 19-21. The Doctor spoke on hepatocarcinoma and cholangiocarcinoma, the two most frequent primary liver tumors.

Hepatocarcinoma is the most common liver cancer, originating in hepatocytes, the main cells of the liver. Cholangiocarcinoma ranks second in frequency in the field of liver tumors and is particularly insidious. It develops in cholangiocytes (the bile ducts between the liver and the intestine) and then grows either inside the organ (intrahepatic cholangiocarcinoma) or outside it (extrahepatic or distal cholangiocarcinoma).

Hepatocarcinoma and immunotherapy: the new therapeutic standard

The treatment of hepatocellular carcinoma with immunotherapy has been under consideration for some years and the topic has been discussed during the Congresses.

A phase III multicenter study (Atezolizumab plus Bevacizumab in Unresectable Hepatocellular Carcinoma), which demonstrated positive results, was published in the New England Journal of Medicine in May 2020. The study evaluated the combination of atezolizumab (immunotherapeutic) with bevacizumab (antiangiogenic). The data indicate a significant improvement in the overall and progression-free survival compared to sorafenib, the drug that has been the standard of care for ten years.

This combination of drugs – approved in the United States and pending approval in Europe – will therefore be the new therapeutic standard in the treatment of hepatocarcinoma not susceptible to locoregional treatments. In Humanitas, this combination is already available to patients as part of a phase IIIB study aimed at further evaluating the tolerability aspects of the treatment.

Markers research continues

“There are also several study protocols on other drug combinations. Moreover, we continue working on identifying markers that can help make therapies increasingly personalized: the goal is to understand which drugs to offer to different patients.

The treatment options for advanced hepatocarcinoma are expanding, making it necessary – and it will only become more crucial – to take into account in our choice of treatment such elements as individual characteristics of the patient, type of drug, efficacy and safety/tolerability, ” explains Pr. Rimassa.

Cholangiocarcinoma, reference centers and a multidisciplinary approach are essential

“Cholangiocarcinoma is less frequent than hepatocarcinoma and the diagnosis is usually late: in 60-70% of cases it is identified at an advanced stage, when the possibilities of treatment and the response to therapies are reduced.

It is therefore essential that patients are treated in specialized reference centers and that the approach is multidisciplinary: cholangiocarcinoma is, in fact, a complex pathology, which comes in different forms and which requires the collaboration of different specialists, such as oncologists, radiologists, interventional radiologists, hepatologists, and surgeons. At Humanitas we offer our patients the care of a multidisciplinary team able to manage the patient in an organic and complete way,” underlines Professor Rimassa.

Cholangiocarcinoma: progress on molecular targets

“As there are some altered genes that recur in patients with cholangiocarcinoma, research in the field focuses in particular on IDH1 (Isocitrate Dehydrogenase 1) mutations and on FGFR2 (Fibroblast Growth Factor Receptor 2) translocations, with some drugs are giving positive responses in studies phase II and III.

Humanitas is involved in some of these studies, and we are making important steps towards the identification of biomarkers for the diagnosis and treatment of cholangiocarcinoma”.